By Kyle David Bates, MS, NREMT-P, CCEMT-P, FP-C
You’ve just received a call, along with fire, for a single-car motor vehicle crash with rollover and entrapment. Now I ask you, “What do you have pictured in your head?” Don’t say anything, just remember that picture when I describe what you see when you arrive.
As you pull up to the scene, you are directed into the traffic management area and placed in front of the heavy rescue so as to allow an area of protection. As you exit the vehicle you notice a four-door sedan in the culvert lying on its passenger side door.
As you approach the vehicle wearing your PPE and reflective vest you note, by looking at the tire tracks, that car simply slid off of the road landing on its side. You see no real damage to the roof nor are there any windows blown out or damaged. As you look through the windshield you notice someone looking back at you with a sheepish grin and an embarrassed wave. It appears that the middle-aged female driver is without injury. You ask her, “Do you have any pain? Are you hurt?” “Just bruised my ego!” she says with an uncomfortable chuckle.
Now this brings us to that mental picture you created earlier. Many of you reading this may have pictured a car that had flipped over at least 360 degrees or more, sustaining damages on all sides of the vehicle. Once thought of as a significant mechanism for injury, a restrained occupant may benefit from a rollover as the vehicle and ground absorb and dissipate the energy as it rolls.
An unrestrained occupant however may not benefit from those same factors, for as the centrifugal forces are applied to the body; there becomes a greater chance that the occupant would be ejected from the vehicle. Hence, morbidity and mortality rates increase dramatically with those that do not remain in the vehicle. So in this scenario, she was not in a rollover but an overturned vehicle. Injuries of belted occupants from these types of crashes I have found to be minimal and generally occur when the seatbelt is released, causing the unprepared occupant to fall to the ground and through any unbroken glass.
The second descriptive term used was “entrapment” but what does this term truly mean? Entrapment generally follows the lines of entanglement; the occupant has become entangled within the structure of the vehicle. This results in the use of cutters, spreaders, and other tools to free the entrapped occupant.
However in this case, the only reason why the occupant was still in the vehicle was that she simply could not exit on her own due to mechanical obstruction, she is confined. A common scenario is the typical “door pop” which occurs when there is enough structural damage to the door that it is unable to be opened. However, responders in these cases should assess for an alternative exit point. Many times the easiest way out may not be the typical or most direct route, such as another door or window.
Returning to our scenario, as the medical team leader you approach the incident commander (IC) to discuss the situation with her. She immediately voices concern over the stability of the vehicle and inquires as to the medical condition of the occupant. You convey that the occupant both appears and voices that she is not injured and that a rapid extrication would not be needed and potentially the occupant may be able to self-extricate if an exit is made.
Due to the soft ground, the IC voices concern over having the occupant climb up and out of the car through the door that is in the air. She states that even with stabilization, this may increase the vehicle’s center of gravity, making it more unsteady so they will cut away the larger rear-window of the vehicle. You agree and inform her that at this time there is no need to have any medical personnel inside the vehicle but will assign one to the area of the front windshield to keep in communication with the occupant, the IC agrees.
Communication is key at any scene, but especially at the scene of an MVC. Communication should be clear, concise, and face-to-face whenever possible. Your choice of words can make a difference in how others perceive the incident and what resources may be required. Establishing the incident management system, which aids and facilitates interdisciplinary communication allows the needs of the extrication team and the needs of the medical team meet the needs of the occupant.